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General NPI Number Information
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NPI Number | 1962620229
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Entity Type | Organization
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Legal Business Name | DANIEL H DE TOLLA, D.D.S., M.D., PA
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 09/08/2009
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Provider Practice Location Address
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Address Line | 200 GRIFFIN ROAD SUITE 8
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City | PORTSMOUTH
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State | NH
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Zip | 03801
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Country | US
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Telephone | 603-436-3608
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Fax | 603-436-3646
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Provider Business Mailing Address
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Address Line | 200 GRIFFIN ROAD SUITE 8
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City | PORTSMOUTH
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State | NH
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Zip | 03801
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Country | US
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Telephone | 603-436-3608
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Fax | 603-436-3646
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Authorized Official
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Title or Position | ORAL SURGEON
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Name | DR. DANIEL HENRY DE TOLLA
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Credential | D.D.S., M.D.
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Telephone | 603-436-3608
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number | 3472
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License Number State | NH
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